The Short and Midterm Outcomes of Local Versus General Anesthesia for Non-Emergency Thoracic Endovascular Repair in...

General anesthesia (GA) has consistently served as the predominant anesthesia modality in thoracic endovascular aortic repair (TEVAR). The objective of this retrospective study was to systematically evaluate and compare the short and midterm outcomes of local anesthesia (LA) versus GA for non-emergency TEVAR in acute Type B aortic dissection (TBAD).

This single-center, retrospective study analyzed 441 consecutive patients who underwent non-emergent TEVAR between January 2016 and December 2020. Following 1:1 propensity score matching, 410 patients were enrolled and allocated into LA group (n=205) and GA group (n=205) based on anesthesia type. Baseline demographics, intraoperative details, postoperative outcomes, and follow-up data were systematically collected and analyzed. Patients were prospectively followed for 5 years post-discharge to monitor long-term outcomes.

Compared with the GA group, the LA group showed significantly shorter anesthesia duration (75 vs 125 minutes, p<0.001), procedure time (60 vs 95 minutes, p<0.001), intensive care unit (ICU) stay (4 vs 18 hours, p<0.001), and hospital stay (25 vs 29 days, p<0.001). However, no significant differences were found in in-hospital mortality (2.0% vs 2.9%, p=0.751) and late mortality (1.4% vs 2.5%, p=0.724) during the 5-year follow-up. Multivariable Cox-regression analysis revealed that chronic heart failure was an independent risk factor for death (HR=4.253, 95% CI 1.243-14.554, p=0.021).

Local anesthesia may be considered non-inferior to GA in patients with acute TBAD undergoing non-emergency TEVAR, with shorter length of ICU and hospital stay. Moreover, it exhibited equivalent 5-year survival rates to GA.Clinical ImpactThese findings demonstrate that LA offers a resource-sparing alternative without compromising survival, thereby supporting a paradigm shift toward LA as a potential primary anesthetic strategy for TEVAR in appropriately selected patients.